Therapeutic hypothermia in cardiac arrest survivors: is rebound hyperthermia a significant issue with intravascular cooling?
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KeywordsTherapeutic Hypothermia Target Temperature Management Northern Ireland Cardiac Arrest Survivor Broad Inclusion Criterion
Out-of-Hospital Cardiac Arrest (OOHCA) is associated with a poor prognosis. Targeted temperature management (TTM) within Intensive Care (ICU) including therapeutic hypothermia (TH) aims to reduce cerebral reperfusion injury and improve neurological outcomes.
Within Northern Ireland (NI), Craigavon Area Hospital (CAH) is the only ICU to implement TH using an intravascular cooling device (Coolgard 3000©, Alsius UK®)
The benefit of TH has recently been disputed and many ICUs within NI have since adopted TTM to 36°C in survivors of OOHCA .
In view of this we aimed to benchmark our use of TH to 32-34°C, using intravascular cooling against best practice at the time of data collection.
Retrospective, observational chart-based data collection.
40 patients admitted to CAH ICU, who received TH via intravascular cooling catheter (24/5/2010-30/11/2012), were identified from the Intensive Care National Audit and Research Centre (ICNARC) database.
35 patients (87.5%) had available relevant and complete data.
Indications for TH.
OOHCA with shockable rhythm
OOHCA with non-shockable rhythm
In-hospital cardiac arrest with shockable rhythm
In-hospital cardiac arrest with non-shockable rhythm
Attempted suicide by hanging
TH using intravascular cooling.
Mean time from ROSC to target temperature of 32-34°C
Mean duration of TH at temperature <34 °C
Neuromuscular blockade use
Rebound hyperthermia (>38°C) on cessation of active cooling
Mean duration of rebound hyperthermia
Mean length of ICU stay
Destination at Hospital Discharge: Home
Destination at Hospital Discharge: Hospice
30 day mortality
Overall our outcomes for a mixed ICU population with broad inclusion criteria for TH are comparable with those of published studies .
The use of intravascular cooling for TH was associated with minimal use of muscle relaxants allowing early neurological prognostication in our patient group.
However intravascular cooling to 32-34°C was associated with prolonged periods of rebound hyperthermia in a significant minority of patients (45.1%, mean time 8.6 hours).
We believe that TH to 32-34°C, using intravascular cooling, increases the risk of developing a rebound hyperthermia that could potentially exacerbate acquired neurological injury.
Our data supports the use of TTM to 36°C to mitigate any potential effect of rebound hyperthermia is this patient group.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.